The long-term objectives of this K24 proposal are to enhance my research productivity and develop new skills in patient-oriented research as well as provide mentorship to increase the number of well-trained clinical investigators capable of providing future mentorship in palliative and end-of-life care. Candidate: As a medical oncologist in thoracic oncology, I am acutely aware of the suffering experienced by patients with advanced cancers and their families. The focus of my research is on developing and testing interventions to improve the quality of life and comprehensive cancer care for patients and their families. I have a strong record of patient-oriented research in palliative and end-of-life care, independent peer-reviewed funding, high quality original publications and effective mentoring. My experience as both a primary research mentor and as Fellowship Director of the Hematology/Oncology training program at my institution over the last seven years has prepared me to expand my mentoring in patient-oriented research. I will substantially alter my current roles and responsibilities to dedicate 50% effort to augment my research program and activities, with a minimum of 25% effort dedicated exclusively to mentoring. I will step down as Fellowship Director (30% effort) to invest time in learning additional research skills and serving new roles i research leadership and mentoring. Environment: The environment at Massachusetts General Hospital (MGH) Cancer Center is ideally suited to support my goals of enhancing my research and mentoring productivity in order to expand the pool of well- trained clinical investigators. The Cancer Center has welcomed and supported the formation of collaborations with palliative care, psycho-oncology, and behavioral medicine to accommodate my novel research program in palliative and end-of-life care. Notably, the Cancer Center has endorsed a new Cancer Outcomes Research Program, under my direction, with the goal of providing mentorship and support to fellows and junior faculty in health services and outcomes research. Additionally, I have access to incredibly talented trainees from Harvard University and Medical School, Harvard-affiliated residency programs, the Dana-Farber/MGH Hematology/Oncology fellowship program, the MGH Behavioral Medicine Program and junior faculty at MGH. Research: My research focuses on evaluating models of integrated palliative and oncology care as well as enhancing clinician-patient communication about end-of-life care. The new projects proposed in this K24 award build on my research in integrated palliative care to study key elements of palliative care communication, communication differences between palliative and oncology care, and the relationship between shared decision-making and patients' end-of life care outcomes. These analyses will allow us to define the roles for palliative care and oncology clinicians to provide optimal care for patients with advanced cancers and to develop data-driven guidelines for best practices and educational programs. The new research in this application also seeks to expand the scope of palliative and supportive care research to patient populations with somewhat better prognosis than those typically included in palliative care studies. These projects offer significant opportunities for mentees to learn how to develop, implement, and test palliative and supportive care interventions. Immediate and Long-Term Career Goal: My immediate career goal is to enhance my productivity and mentoring efforts in patient-oriented research in palliative and end-of-life care. This K24 proposal coincides with a plan to restructure substantially my current responsibilities as I step down as Fellowship Director and take on new roles as Director of the newly-established Cancer Outcomes Research Program and as mentor for the MGH Cancer Center K12 Program. My long-term career goal is to be at the forefront of palliative and end-of-life care research that establishes evidence-based standards for providing comprehensive cancer care, while mentoring the next generation of clinical investigators. This field of intervention development to improve the experience of patients and their families and enhance patient-clinician communication is in its infancy. To enable this program of research to flourish, I strive to conduct the highest quality patient-oriented studies and mentor junior investigators, with the aim of improving the quality of life and care for individuals impacted by cancer. Key Elements of the Research Career Development Plan: My career development plan includes a training strategy to ensure that the K24 award augments my patient-oriented research and mentoring goals. Specifically, I will collaborate with two of the nation's leading communication experts, learn new skills in qualitative methods and medical decision-making, and complete on-site training with experts in palliative care intervention development and education. The training plan will substantially add to my current research skills by enabling me to study the communication techniques used palliative care clinicians and how their approach differs from communication by oncology clinicians. I will also train in medical decision-making to investigate the relationship between shared decision-making and patients' decisions about care at the end of life.